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Clinical effects of physiologic lesion testing in influencing treatment strategy for multi-vessel coronary artery
Harsh Rawal1, Tung D Nguyen2, Efehi Igbinomwanhia3
1University of Connecticut, St Francis Hospital, Hartford, CT, United States of America.
Insights
Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) testing in multivessel coronary artery disease (CAD) can influence treatment decisions, potentially increasing percutaneous coronary intervention (PCI) use. This study examined how FFR/iFR guided strategy in CAD patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Multivessel coronary artery disease (CAD) management requires careful consideration of treatment strategies.
- The role of invasive physiologic assessment using fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) in guiding treatment for multivessel CAD is not fully established.
- Understanding how FFR/iFR values influence clinical decisions in the context of target versus non-target lesions is crucial.
Purpose of the Study:
- To assess treatment strategy decisions based on FFR/iFR values in multivessel CAD patients.
- To determine if treatment selection was influenced by whether the tested vessel was the primary clinical target stenosis.
- To evaluate the impact of FFR/iFR on the choice between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
Main Methods:
- Inclusion of 270 consecutive patients with angiographically diagnosed multivessel CAD who underwent FFR/iFR testing.
- Classification of patients based on initial angiographic findings and subsequent re-evaluation using FFR/iFR results (normal or abnormal).
- Categorization of tested lesions as either target or non-target based on clinical and non-invasive evaluations.
Main Results:
- Abnormal FFR/iFR values were observed in 51.9% of patients, leading to PCI in 51.4% and CABG in 44.3%.
- In two-vessel CAD, medical therapy was favored for normal target lesions (72.6%), while PCI was preferred for abnormal targets (78.4%).
- PCI was favored for non-target lesions irrespective of FFR/iFR results (78.0%). CABG was preferred for abnormal target lesions in three-vessel CAD (68.5%).
Conclusions:
- Invasive physiologic testing with FFR/iFR can significantly alter preferred treatment strategies in multivessel CAD.
- The findings suggest a potential increase in PCI utilization when FFR/iFR is employed in the management of multivessel CAD.
- Treatment decisions are influenced by the FFR/iFR status of the target lesion, particularly in two-vessel disease.
Background:
The application of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) in multivessel coronary artery disease (CAD) patients has not been definitively explored. We herein assessed how treatment strategies were decided based on FFR/iFR values in vessels selected clinically. Specifically, we sought to determine whether treatment selection was based on whether the vessel tested was the clinical target stenosis.
Methods:
270 consecutive patients with angiographically determined multivessel disease who underwent FFR/iFR testing were included. Patients were classified initially based on their angiographic findings, then re-evaluated from FFR/iFR results (normal or abnormal). Tested lesions were classified into target or non-target lesions based on clinical and non-invasive evaluations.
Results:
Abnormal FFR/iFR values were demonstrated in 51.9 % of patients, in whom 51.4 % received coronary stenting (PCI) and 44.3 % had bypass surgery (CABG). With two-vessel CAD patients, medical therapy was preferred when the target lesion was normal (72.6 %), while PCI was preferred when it was abnormal (78.4 %). In non-target lesions, PCI was preferred regardless of FFR/iFR results (78.0 %). With three-vessel CAD patients, CABG was preferred when the target lesion was abnormal (68.5 %), and there was no difference in the selected modality when it was normal. Furthermore, the incidence of tested lesions was higher in the left anterior descending (LAD) compared to other coronary arteries, and two-vessel CAD patients with LAD stenoses were more frequently treated by PCI.
Conclusion:
The use of invasive physiologic testing in multivessel CAD patients may alter the preferred treatment strategy, leading to an overall increase in PCI selection.
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